title: A lower fistula rate in hypospadias surgery.
abstract: OBJECTIVE
  To determine whether specific steps taken after a critical quality control of our results in hypospadias surgery lead to a decrease in fistula rate.
  
  
  METHODS
  Retrospective review of prospectively collected data. Between 1994 and 2001, our series of 85 tubularized plate urethroplasties (modified Duplay or Duplay-Snodgrass procedure) had a fistula rate of 25.9%. In 2001, we modified our approach by systematically padding the urethral suture with a layer of vascularized subcutaneous preputial tissue, as described by Snodgrass. Scrotal hypospadias were excluded. Surgical outcome was assessed at 1 and 12 months. In both groups, all repairs were performed by or under direct supervision of the senior author (BJM).
  
  
  RESULTS
  After 2001, 57 hypospadias repairs were performed in 57 patients aged 8 months to 14 years (median 1.4 years). Fistula occurred in two cases, one of which closed spontaneously within 6 months. Our fistula rate had dropped to 3.5%, with a minimum follow up of 12 months.
  
  
  CONCLUSIONS
  Covering the urethral suture with a padding flap of vascularized preputial tissue helps avoid fistula formation. Technique modification after critical appraisal of our own series led to a much better outcome in this demanding surgery.
authors.affiliation: Department of Paediatric Surgery, Centre Hospitalier Universitaire Vaudois, Rte du Bugnon 46, CH-1011 Lausanne, Switzerland. christophe.gapany@chuv.ch
authors.forename: Christophe
authors.initials: C
authors.lastname: Gapany
authors.forename: Nicolas
authors.initials: N
authors.lastname: Grasset
authors.forename: Stéphane
authors.initials: S
authors.lastname: Tercier
authors.forename: Pascal
authors.initials: P
authors.lastname: Ramseyer
authors.forename: Peter
authors.initials: P
authors.lastname: Frey
authors.forename: Blaise J
authors.initials: BJ
authors.lastname: Meyrat